Health workers will end strike when FG is ready to implement agreement with us –Yakasai, PSN President

The President of the Pharmaceutical Society of Nigeria, Ahmed Yakasai, throws light on the reasons for the protracted strike by the health workers in the country. He also discusses contemporary pharmaceutical matters, among others, in this interview with JESUSEGUN ALAGBE

The Joint Health Sector Unions and Assembly of Health Care Professional Associations, an association of health workers in the country, has been on strike since April 17. When is it likely to end?

First of all, at the root of the current avoidable strike action and those in the past is the desire for benefit packages and privileges for all health workers. The clamour for these benefits appear to have been grossly ignored by the government at all levels over the years. It is important to take a walk down memory lane that contrary to the superiority mentality created in some quarters, pharmacists and doctors entered the public service on the same grade level up until 1991.

Pharmacists started on Grade Level 08 Step 2, while doctors started on GL 08 Step 3 because of the one-year difference in the duration of training. After the mandatory one-year National Youth Service, pharmacists proceeded to GL 09 Step 2 and doctors to GL 09 Step 3. This was the pattern until the Olikoye-Kuti leadership in the Federal Ministry of Health got the military administration of General Ibrahim Babangida (retd.) to approve the Medical Salary Scale, a discriminatory salary scale in favour of medical doctors in public service.

The MSS obviously disrupted the equilibrium of public sector wages as it became the basis for other sectoral players to request for exclusive wages. In 2009, the administration of late President Umaru Yar’Adua adopted – on the prompting of the Federal Ministry of Health – new salary scales for the health sector. A CONMESS scale was approved for medical doctors, while CONHESS was the scale of choice for other health workers, including the rank and file of all health professionals.

The fundamental spirit of the adoption of the CONMESS and CONHESS scales in 2009 was to ensure relativity of the two at all times. Meanwhile, after the tinkering of the hitherto existing public sector wage structure in 1991, the salaries of pharmacists and doctors were distorted significantly, such that doctors began to enjoy an extremely significant difference in wages with at least one full grade level difference without any change in the duration of training – five years for pharmacists and six years for doctors. From an initial difference of N7.00 monthly or N84.00 per annum prior to 1991, the difference in entry point for these two personnel now runs into about N1.2m per annum.

Despite this scenario, pharmacists and other health workers on the CONHESS scale took the matter with calmness until more provocative incremental adjustments were awarded doctors – first in January 2014 and then in September 2017. On both occasions, the enabling circulars to legitimise the increases for doctors took only 14 days. Pharmacists and other health professionals have been agitating for adjustment for relativity of both scales as entrenched in the 2009 Memorandum of Understanding with the Federal Ministry of Health. This led to a strike of health workers in 2014 and 2017.

On September 30, 2017, JOHESU/AHPA and the Federal Government signed a five-term settlement agreement to resolve the strike of health workers. The agreement was to be actualised within five weeks with circulars effective from September 30, 2017. It is sad to tell you that almost seven months after the agreement with the Federal Government, nothing has evolved from the legitimate agreements we had with the Federal Government.

The strike might end when the government shows commitment to fully implement the terms of agreement reached with health workers on September 30, 2017. The minimum demand is the immediate issuance of a circular to adjust CONHESS scale as was done with CONMESS to ensure relativity. We also insist that now is the time for the Office of the Head of Service of the Federation to issue the enabling circulars for consultancy cadre in the public service.

Despite your clamour for equal pay with doctors, the Federal Government has said it cannot give in to such demand. Does this mean this strike has no end in sight?

The Federal Ministry of Health and some other stakeholders have been peddling misinformation that equal pay with doctors is the basis of the strike. At the heart of this matter is the demand to restore relativity in the CONMESS and CONHESS scales based on the MoU we signed in 2009. This is about equity, not equality. Even pharmacists who hitherto entered public service on the same grade level as doctors until 1991 are not discussing equality. It is a creation of the Federal Ministry of Health, which oftentimes acts as the spokesperson for all medical doctors.

The Minister of Health, Prof. Isaac Adewole, said recently that in September 2017, JOHESU/AHPA presented a 15-point demand to the Federal Government, out of which 14 had already been implemented while the last demand was being attended to by a high-level body set up by the government to look into its implementation. Rather than go on strike, why didn’t JOHESU/AHPA await the outcome of the decision by the body?

It will be necessary to approach the same minister to tell you the 14-point demand he has implemented and the outstanding item. As far as we know, the Federal Ministry of Health and its henchmen have only embarked on witch-hunt and vindictive purposelessness to deal with the demands of health workers.

Workers proceeded on a strike on April 17, 2018 and the Federal Ministry of Health immediately invoked a no-work-no-pay rule. Even under labour laws, a worker who has worked for at least 15 days is entitled to full pay. The Federal Ministry of Health has also dictated the opening of attendance register and other sinister tactics to humiliate these workers. I have news for Prof. Adewole, who we used to exalt at the PSN, that these measures will and have failed because more than ever before, health workers are very resolute.

In all of these, what are the specific demands of the Pharmaceutical Society of Nigeria, or are they the same with what JOHESU is demanding?

The Pharmaceutical Society of Nigeria demands that the enabling circular to adjust the CONHESS scale like it was done with CONMESS in 2014 and 2017 be issued immediately as agreed. We also request that President Muhammadu Buhari direct the issuance of the circular that legitimises the consultancy cadre for pharmacists in public service as approved by the National Council on Establishment.

We strongly recommend that to stem the tide of industrial disharmony in the public service, the Federal Government must restructure the wage pattern to fit into one universal scale which gives preferential entry point to those who have longer duration of training to enable them to enter at higher steps on the Universal Salary Scale as a permanent intervention.

The Pharmaceutical Society of Nigeria has always been mature and peaceful in its agitations, but this has made us very vulnerable to exploitation by some stakeholders. In the current dispensation, we demand justice and equity for all concerned without further delay in the interest of health consumers in the country.

PSN has always strongly frowned on the abuse of drugs, particularly codeine and tramadol, among youths in the country. How then does the society feel about the recent ban of the products by the Federal Government?

First, we praise the professionalism of the BBC Africa Eye for producing the documentary on codeine abuse and their bravery in unraveling the decadence the PSN has been raising the alarm about in the last few years but more loudly in the last six months.

For long, we had always drawn the attention of the public to the enormous amount of cough syrup being abused, especially in the north, leading to advocacy visits to the Senate President [Dr. Bukola Saraki]; Speaker of the House of Representatives [Yakubu Dogara]; traditional rulers; governors of the affected states and the Director-General of the National Agency for Food and Drug Administration and Control.

We had also always strongly condemned the unethical practices by some of our members and consistently educated, retrained, certified and advocated ethical practice by members. We also have in place a system for reporting unethical practices discretely, that is, whistle-blowing.

We still currently work with regulatory agencies like the Pharmacists Council of Nigeria and NAFDAC to improve regulation by ensuring laws are updated to reflect current realities, motivate easy compliance, promote integrity of the drug supply chain and provide sufficient deterring penalties to wrongdoers. In this light, our advocacy to the Senate has yielded impactful consideration and several partnerships targeting the supply and demand of codeine containing cough syrups.

However, we are calling on the Federal Government not to renege on its commitment to implementing the National Drug Distribution Guidelines slated for January 2019. The implementation of these guidelines will result into better regulation of medicine distribution and improve the ability of regulators to audit the trail of drugs.

What has the society been doing to get President Buhari sign the Pharmacy Council of Nigeria Bill, which is meant to regulate the manufacturing and sale of drugs in the country?

I am sure you will agree that such information cannot be disclosed here. However, I believe the President will soon complete the process. Nevertheless, we must appreciate the leadership of the Senate for showing interest in the drug distribution regulatory processes. The attempt to promulgate two different Acts of Parliament is laudable, but we must be cautious, particularly because of the funds required for their sustainability. The two new bills are the Drug Control Bill and Mental Health Bill.

Part of the bane of our health sector has always been extremely wretched appropriations. Poor funding has continuously hampered the regulatory activities of the PCN, NAFDAC and the National Drug Law Enforcement Agency to varying extents. How can regulatory agencies which do not have the specialised manpower, vehicles and gadgetry deliver on their mandates?

For instance, the PCN registers and inspects pharmaceutical premises in Nigeria and while it has registered about 6,000 premises in different cadres of practice, intelligence information has revealed that over a million illegal premises exist in the country. But how do we mobilise men and other logistics in the face of dearth of funds?

I, therefore, think that the most pragmatic way moving forward is to strengthen the existing agencies in drug distribution to enable them to meet their statutory mandates.

Apart from the regulation of drugs in the country, what other issues will the PCN bill address?

The bill is geared towards attaining better regulatory control of all pharmaceutical premises, pharmacists and other personnel in the pharmacy practice and training schools across board. We are driven by a deep sense of conviction that consumers of health will have a better deal once this bill is transcended to an Act of Parliament.

Recently, the PSN opposed a move by the Nigerian Veterinary Association to re-enact the Veterinary Surgeons Act 2016.smuggle, a bill that, among others, seeks powers for registration and regulation of professional veterinary practicing premises. Why is the PSN so concerned about a bill by another profession?

The implication of the bill is that veterinary doctors would now have the powers to regulate and register premises where veterinary drugs can be dispensed or distributed.

Meanwhile, sections 15 and 16 of the Poisons and Pharmacy Act Cap 535 places restrictions on the sale and delivery of poisons. The law requires that only pharmacists shall sell or deliver poisons on the written prescription of a registered medical practitioner, registered dental surgeon or registered veterinary surgeon. This highlights the sensitivity the relevant statutes attached to drugs of this nature.

Veterinary practice and premises regulation fall under the special powers of the PCN. Therefore, creating another group of veterinary pharmacy/veterinary drug shop under the supervision of veterinary surgeons will be a call for anarchy, especially when these provisions have not been repealed.

The recently passed Pharmacy Council of Nigeria Bill by the National Assembly also gives specific approbation to the PCN to continue to perform these functions. We also draw the attention of the National Assembly to the age-long golden rule in health care that bars the prescriber from dispensing at the same time. This rule guides against the prescriber from deriving economic benefits from the process of dispensing and sales of medication. The rule also insists on the dispenser not deriving economic benefits from the process of prescribing, allowing both to act in the best interest of the patient.

This rule is at the heart of separating the diagnosis and prescribing functions of doctors and veterinary surgeons from the dispensing and pharmaceutical care functions of pharmacy/pharmacists.

Significantly, what this bill is proposing is that the dental surgeon can also have the right to operate pharmacies and drug shops with its potential for abuse and conflicts. The bill must not be allowed to see the light of day.

Your opposition to the bill may possibly bring conflict between the two professional bodies. How do you intend to prevent this from happening?

We presented this matter at a recent public hearing and our prayers included: First, any professional or professional body interested in running a pharmacy or drug store must seek the licensure of the Pharmacists Council of Nigeria like it has been since we first had the Pharmacy Ordinance of 1882. Global best practice must prevail in the circumstance.

Second, pharmacists are the only group of professionals licensed to deal in medicines – the veterinary medicines/drugs are the same as for humans.

Third, there is need to ensure harmonisation of activities, and therefore the PCN and NAFDAC should be further strengthened for their regulatory activities and functions.

Fourth, the National Drug Policy 2005 provides for the control of veterinary drugs by the PCN and NAFDAC.

Fifth, appropriate directives should be given to all concerned to comply with the existing statutes and the dictates of the National Drug Policy 2005, which is a collaborative document produced under the auspices of the Federal Ministry of Health, World Health Organisation, Department for International Development and the European Union with regards to the registration of veterinary drugs in Nigeria.

So, we do not set out to engage any other profession for a popularity contest because it is not usually a positive agenda. If you, however, encroach on our area of competence, we have a responsibility to curb such incursion. We also affirm its readiness to partner with all stakeholders in the obviously arduous task of ensuring standards in all facets of health care in the country.

For long, the country has mainly relied on imported drugs. What is a body like the PSN doing to push the country forward in manufacturing its own drugs on a large scale?

We don’t have statutory powers to compel local manufacturing. But we have and will continue to advocate that the Federal Government, through the Ministry of Health, should follow the dictates of its own National Drug Policy which preaches the gospel of local manufacturing by advocating attainment of 70 per cent status in self-sufficiency of essential drugs as a target which should have been met over a decade ago.

Are there specific constraints affecting the local production of drugs and how is the society helping to remove such barriers?

We all know them. Poor electricity, water, poor roads and other poor infrastructure. These and so many others increase the cost of production and, therefore, do not make local manufacturing attractive to entrepreneurs in and beyond our industry. The Pharmaceutical Society of Nigeria is limited in its capacity to provide a conducive environment, but what we owe Nigeria is the expertise in manufacturing. It is heartwarming to put on record that we have expertise with a plethora of technocrats all over.

The World Health Organisation recently clocked 70. Is there any partnership between the organisation and the PSN?

The Pharmaceutical Society of Nigeria celebrates the achievements of the WHO in the past 70 years and the progress it has made so far in improving the quality of people’s lives. The PSN will continue to work with WHO and other partners for the well-being of all Nigerians.

We also encourage all stakeholders to learn from the leadership structure at the WHO, especially the process that produced its Director-General, who is not a medical doctor, but is supported by all and sundry.

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